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13 Jun 2024

The Health & Wellbeing Connection

Health & Wellbeing

Like a double-sided mirror where one side is magnified to give a more detailed view, so are health and wellbeing inexorably linked. The two words are often joined into a single definition or randomly exchanged each for the other. There is a well-established saying that seems to apply to the use of these two words as a phrase: ‘we talk past each other when we do not share understanding and when we do not make an effort to understand what the other person is actually talking about’. Here’s why this saying fits.
Aotearoa New Zealand standard definition for health & wellbeing

Aotearoa New Zealand officially recognizes two fully aligned definitions that show the interplay of health and wellbeing. Both these definitions demonstrate that overall balance is what is required for individuals to experience wellbeing, with some factors compensating for others at different ages and stages of one’s life. This means that people with long-term conditions can, and frequently do, experience wellbeing. Even at the end of life when one’s health is failing, and cannot be reversed, it is possible to experience wellbeing if there is overall balance.

In Aotearoa New Zealand the statutory, regulatory, and policy documents of many central government ministries (e.g. health, social development, education, etc.); local government authorities and member agencies; non-government, private, charitable, voluntary and philanthropic organisations, and other groups; most use the definition of health announced by the World Health Organization in 1948; many also use the Māori model of health & wellbeing Te Whare Tapa Whā, published and explained to New Zealanders since 1984 by Dr Mason Durie (now Sir and Professor).   



The WHO connection

Founded in 1948, The World Health Organization (WHO) defined, “Health is a state of complete physical, mental, social, emotional and spiritual well-being, not merely the absence of disease (illness) or infirmity (long-term conditions)”. That definition remains unchanged across the world. Note the words in brackets is the language of the current day for the words in the definition.

In 1948 WHO defined the principles that underpin the above definition, these remain current today:

  • The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
  • The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States.
  • The achievement of any State in the promotion and protection of health is of value to all.
  • Unequal development in different countries in the promotion of health and control of diseases (illnesses), especially communicable (preventable) disease, is a common danger.
  • Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.
  • The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.
  • Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.
  • Governments have responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.
World Health Organization (WHO) explains its above definition of health:

Many factors combine together to affect the health of individuals and communities. Whether people are healthy, or not, is determined by their circumstances and environment.

To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impact on health and wellbeing, whereas the more commonly considered factors such as access to and use of health care services often have a secondary impact.

The determinants of health as summarised by WHO:
  • The social and economic environment,
  • The physical environment, and
  • The person’s individual characteristics and behaviours.

The context of people’s lives determines their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. The above determinants of health – the things that make people healthy or not – include the following factors, and many others too:

  • Income and social status – higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
  • Education – low education levels are linked with poor health, more stress and lower self-confidence.
  • Physical environment – safe water and clean air, healthy workplaces, safe houses, communities, and roads all contribute to good health. Employment and working conditions – generally people in employment are healthier, particularly those who have more control over their working conditions.
  • Social support networks – greater support from families, friends and communities is linked to better health. Culture – customs and traditions, and the beliefs of the family and community all directly affect health.
  • Genetics – inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain diseases (illnesses). Personal behaviour and coping skills, such as: balanced eating, keeping active, smoking, drinking alcohol, and how we deal with life’s stresses and challenges all affect health.
  • Health services – access and use of services that prevent and treat disease (illness) influences health.
  • Gender – men and women are predisposed to different types of diseases (illnesses) at different ages.
Why an evidence-based approach is important for addressing health inequity.

WHO has recommended since it was founded in 1948, that an evidence base about the projected and actual impact that policies, programmes, and projects have on health be conducted to identify the health impact assessment (HIA).

WHO recommends the best available evidence be used within the appraisal stage of HIA to determine what impacts may occur (both positive and negative), the size of the impact (if possible) and the distribution of that impact on specific population groups. It is generally assumed that the evidence for health impacts exist (health as per WHO definition), and that searching and collating will provide the necessary evidence.

WHO explains that unfortunately, this is not always the case, the evidence of health impacts is frequently not available. This is because of the long causal pathway between the implementation of a policy / programme / project, and any potential impact on the health of populations and sub-population groups, and the many confounding factors that make the determination of a cause and effect link difficult. Within the HIA it is important therefore to be explicit about sources of evidence and to identify missing or incomplete information.

Providing a comprehensive review of the evidence base is not simple. It needs to draw on the best available evidence – that from reviews and research papers and including quantitative evidence (e.g. numbers, costs, etc) and qualitative evidence (e.g. lived experience of ‘target group’ people). This information must be supported with local and expert knowledge, policy information, and proposal specific information.

There are examples where the best available HIA evidence is documented and summarised using a robust and validated framework that displays and enables impacts within and across interdependencies to be easily understood, quantified and qualified. For example, the generic determinants of health framework are commonly used in WHO and United Nations programmes and projects, to present a comprehensive HIA. The domains of the generic determinants of health framework are:

  • Individual factors, such as: age, gender, genetics, confidence, trust, meaning in life, hope.
  • Psychosocial factors, such as: social support, networks, cohesion.
  • Lifestyle factors, such as: habit and behaviours.
  • Socioeconomic factors, such as: education, occupation, income.
  • Arena factors, such as: housing & neighbourhood, education facilities, leisure activities, working conditions, communication and digitalisation, health and social services.
  • Environment factors, such as: ecological, social, cultural, economic, political, existential.
WHO identifies that Primary Health Care has a critical role in the health of populations.

Primary health care should be a whole-of-society approach to effectively organise and strengthen national health systems to bring services for health & wellbeing closer to communities. WHO recommends primary health care requires the following three components:

  • Integrated health services to meet people’s health needs throughout their lives.
  • Addressing the broader determinants of health through multiple sectors planning the required strategies and actions, then working together to deliver the agreed plan (e.g. Social Housing Developments must involve: Local Council, Iwi, other Ethnic Group Agencies, local health care providers, community groups representing the target group for the housing, funding entities; etc).
  • Enabling individuals, families, and communities to take charge of their own health.

Primary health care done well enables health systems to support a person’s health needs – along the continuum which includes health promotion, disease (illness) prevention, diagnosis, treatment, rehabilitation, palliative care, and end of life care. This strategy also ensures that health care is delivered in a way that is centred on people’s needs and respects their preferences.

Primary health care is regarded by WHO as the most inclusive, equitable and cost-effective way to achieve universal health coverage. It is also key to strengthening the resilience of health systems to prepare for, respond to, and recover from shocks and crises.   

Te Whare Tapa Whā Definition of Health & Wellbeing

Continually increasing numbers of organisation’s spanning public, private, non-government, charitable, voluntary, philanthropic, and other sectors have adopted Te Whare Tapa Whā Model of Health & Wellbeing, that Dr Mason Durie (now Sir and Professor) explained and published in 1984.

Like the WHO definition Te Whare Tapa Whā encapsulates the whole person, keeping the person at the centre – it uses the four walls of a house (whare) and its foundations (whenua), as the imagery of the balance required to experience health and wellbeing (i.e. there can be weaknesses in parts of some or all walls, but if the core structure is solid the house will remain standing). If we are not feeling our best, it is important to consider each wall (area) and see what we can change to support and strengthen what is temporarily or permanently weakened.

The four walls and base of Te Whare Tapa Whā are: 

  • Taha tinana is our physical health & wellbeing; being the structure and functions of the organs, blood vessels, bones, muscles, tendons, etc throughout our body.
  • Taha hinengaro is our mental and emotional health & wellbeing; being our brain functions, thoughts and feelings.
  • Taha whānau is our family and social health & wellbeing. This means feeling connected to the people that matter to you, it includes whakapapa /genealogy, identity and culture/heritage, and having a place and a role within all of that.
  • Taha wairua is our spiritual health & wellbeing. This means our beliefs, values, traditions, and practices, the things that support our self-awareness and help build our identity.
  • Whenua is the foundation on which the above four walls sit. The firmer the foundation the stronger our health & wellbeing is. The whenua is the special place we identify with, where our roots are. It is our connection to the land (e.g. the country/city/town/rural location of our birth and/or ancestry) and its landscape (e.g. the mountain/hills, sea/river, etc we identify with).

The WHO definition and Te Whare Tapa Whā are fully aligned definitions of health & wellbeing, they both show us that:

  • Health is not limited to the structure and functions of our body and mind.
  • That health & wellbeing cannot be achieved without balance across multiple components, this is most easily understood by the imagery of the four walls and base of Te Whare Tapa Whā.
  • Both definitions show that all the component parts of each wall don’t need to be whole for the walls to remain standing – meaning that at various ages and stages of our life parts of one or more walls may be less strong than the others, but if the core structure of the whare (house) is strong it will be a solid structure.
  • Hence explaining why even in our last days of life we can achieve a sense of wellbeing.

The NZ Mental Health Foundation has an easy-to-understand way of defining health & wellbeing.

“Feeling Good and Functioning Well”.

They say when we check in with ourselves (and others), we can ask:

Am I feeling okay and able to do the things I need to?

If the answer is yes, our health & wellbeing is good.         


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Published: June 2024

To be reviewed: April 2027